Do internal facelift stitches dissolve?

Question

I’m particularly worried that an internal stitch may be pressing on my auricular nerve as I’ve heard some of you mention that this could happen. If my auricular nerve is somehow surrounded by a stitch, can my surgeon do an X-ray to see this? And if the internal stitches are dissolvable, how long does it take for them to dissolve? Thanks so much!

Michael Boggess, MD · Answer

Hello.  Thank you for your question.  Some surgeons use absorbable sutures and some surgeons use permanent sutures when performing facelift.  It is simply a matter of surgeon preference.  I personally prefer absorbable sutures, because permanent sutures can sometimes cause a localized inflammatory response, called a suture granuloma, that may occur even several years after surgery and may require removal of the offending suture.  There are different types of absorbable sutures that may be used.  Most of the common absorbable sutures used in facelift surgery will be gone in 3 - 6 months.  Obviously, permanent sutures will remain forever, unless surgically removed.  If you are having symptoms that may be related to greater auricular nerve compression, such as numbness of the ear or pain, it will likely resolve over time as swelling and inflammation around the nerve resolves from surgery.  There is no x-ray that would demonstrate these sutures, but your surgeon likely knows exactly where the sutures were placed during your procedure.  If you are concerned, I would encourage you to follow-up with your primary surgeon to discuss your concerns and make certain that everything is healing as expected.  I wish you the best in your recovery.

Gregory DeLange, MD · Answer

Why do you think it is pushing on your nerve?  How long ago was the surgery?   Xrays do not show the sutures and there should not be any around your great auricular nerve anyway.  Usually the the sutures use do not dissolve but some do use absorbable.   If you are having ear pain, it should within a month after surgery.

Sam Speron, MD, FACS · Answer

It seems that you're unhappy with your scars from your previous surgery. To answer your one question, yes usually they are unless permanent.I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelifts if you want a second opinion and of course, make sure you follow up with your own surgeon and talk about this. I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Brian K. Machida, MD, FACS · Answer

Internal sutures cannot be seen on x ray.  Also, depending upon the dissolvable suture, some sutures can last for several months but will loosen with time.  Theoretically, if the nerve sheath is intact, the nerve will recover but may take time.  Strangulation of the nerve by a suture in surrounding tissue will interrupt nerve function by cutting off axonal flow.  In these cases, the nerve sheath should remain intact and therefore nerve function is recoverable. A similar situation could be caused by heat from nearby cauterization  Cases of non recovery can be due to actual nerve injury from dissection, but there is difficulty in determining this upon re exploration. For the most part, these situations cause numbness and not pain.  If your primary concern is numbness, it is usually best to wait and follow with your doctor. If your symptom is prolonged pain, it may represent a different situation for which you will need to follow with your doctor.

Boris M. Ackerman, MD · Answer

Facelift results are much more dependent on the technique, as opposed to the type of sutures that are used. In my facelift practice, we use long acting, but absorbable sutures. In this fashion there are no foreign bodies left behind. As for your concerns regarding the nerve, even after the suture has dissolved it can still take a few months to see how well the nerve will regenerate. It is always best to discuss your concerns with your plastic surgeon.

Stephen H. Fink, DO, FAOCO · Answer

Hello,
Just as there are many types of facelifts, there are also many types sutures used in a facelift. The choice depends on your surgeons technique and preference. Many surgeons use dissolvable sutures.  The length of time for them to dissolve varies by suture material and also according to how your body reacts to them. (Usually several weeks to months). Some surgeons use non- dissolving sutures for portions of their procedures. Most of these are not treated to show up on X-rays. Either way, it is possible to have a suture around a branch of a sensory nerve below the ear (auricular nerve). These branches can also be injured in the dissection.  Numbness of the skin and ear can be normal for several weeks but eventually resolves in time.  Pain is normal within the first week but usually improves  within days. Prolonged pain in one particular spot can indicate an issue with a particular nerve branch.  It is important to make your surgeon aware if you are experiencing new, prolonged or asymmetric symptoms. 
Best to you,
Stephen H Fink DO, FAOCO
Facial Plastic Surgeon

Kyle T. Yamamoto, MD · Answer

Depending on the surgeon and technique, some sutures under the skin may be dissolvable, some sutures may be permanent.  Either suture is a safe option overall.Sutures that are dissolvable typically take 3-6 months to fully disappear.  Permanent sutures remain under the skin, and you should not be able to feel them.X-rays and other imaging will not be able to "see" any of these sutures.A suture near the greater auricular nerve is not dangerous and can stay there without any issues.  Only if you had problems with prolonged or permanent numbness in this area could a suture potentially cause an issue with this nerve.Overall, sutures under the skin should not bother you over time.  If you have any questions about the specific sutures used in your surgery, I recommend you talk to your surgeon.

Robert Applebaum, MD · Answer

There are different types of sutures used in facelift surgery.   Over the greater auricular nerve there may be absorbable or non absorbable sutures.  Your concern will likely resolve over time when the sutures relax and the nerve will recover.  Let some additional time pass and your symptoms will resolve.  There is no X ray or other diagnostic study to show the position of the sutures.

Hector Gonzalez Miramontes, MD (in memoriam) · Answer

Please know that it takes three to six months for dissolvable stitches to absorb completely. In the future, please note because dissolvable stitches produce more swelling and more postoperative complications, permanent sutures are best. Miramontes.

Robert E. Zaworski, MD (retired) · Answer

Internal facelift sutures dissolve over a period of several weeks.  After the sutures have dissolved it can still take a few months to see how well the nerve will regenerate.  It is always best to discuss your concerns with your plastic surgeon.

Do internal facelift stitches dissolve?

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